FUNDING/SUPPORT: Dr Middlekauff is supported by the Tobacco-Related Disease Research Program Exploratory/Developmental Research Award [TRDRP-XT 320833] and the American Heart Association, Western States Affiliate, Grant-in-Aid [15GRNT22930022].

FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Extract

Drs Avdalovic and Murin1 raise an important question: What do we say to our patients and others who inquire about electronic cigarettes (e-cigarettes)? I disagree with their dogmatic stance that in the absence of definitive proof that e-cigarettes are safe, we must assume that they are not. The science indicates that a more nuanced response will best serve the health interests of these patients.

e-Cigarettes are not cigarettes at all, since they do not contain tobacco and they are not combusted. Essentially, they are a new form of nicotine inhaler. Failure to acknowledge this fact has led to an emotion-based, not evidence-based, response to e-cigarettes. Combustible-tobacco cigarettes have been, and remain, the number one preventable cause of heart disease and lung cancer, responsible for one-half million premature tobacco-related deaths each year in the United States, and 6 million worldwide. Despite evidenced-based campaigns for smoking cessation, smoking rates remain steady in the United States and are actually increasing in less affluent countries.

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